Journal of anesthesia
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Journal of anesthesia · Oct 2020
Randomized Controlled TrialThromboelastometry and a hemostasis management system are most beneficial for guiding hemostatic therapy in cardiac surgery patients with a EuroSCORE II of ≥1.83%: a randomized controlled two-step trial.
We evaluated the efficacy of hemostatic therapy based on point-of-care (POC) testing in patients undergoing cardiac surgery. ⋯ POC testing is beneficial for cardiac surgery patients with a EuroSCORE II of ≥1.83%.
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Journal of anesthesia · Oct 2020
Case ReportsEvaluating coagulation status with thromboelastography in a woman with antiphospholipid syndrome and sepsis: a case report.
This study presents the case of a pregnant woman with antiphospholipid syndrome (APS) who developed septic shock after labor induction. Prolonged coagulation times suggested a hypocoagulable state and contraindication to anticoagulation. Thromboelastography (TEG) similarly indicated hypocoagulation. ⋯ The patient's coagulation state significantly improved. Based on these findings, anesthesiologists and obstetricians should be aware that TEG might not be a reliable method of correcting coagulation parameters in patients with sepsis in the presence of aPL. If necessary, a mixing test can be performed to correctly define a patient's coagulation status.
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Journal of anesthesia · Oct 2020
History of the development of antagonists for neuromuscular blocking agents.
Muscle relaxation induced by neuromuscular blocking agents (NMBAs) is necessary for tracheal intubation and immobilization during surgery. Although acetylcholinesterase inhibitors have been successfully used as antagonists for NMBAs, they have their limitations; their effects are transient and ineffective against profound neuromuscular blockade. In the past, alternative antagonists were developed, such as germine and 4-aminopyridine, which are effective for the treatment of diseases causing muscle weakness and could potentially be used as antagonists for NMBAs. ⋯ Their effects can be reversed by the amino-acid L-cysteine. More recently, calabadions have been developed, which can form complexes with both steroidal and bisbenzyl-isoquinolinium NMBAs, in a similar fashion as sugammadex. Understanding the history of the NMBA antagonist's development is interesting and useful for modern anesthesiologists since it enhances their knowledge about the mechanisms involved in neuromuscular transmission and might lead to the development of ideal NMBA antagonists.
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Journal of anesthesia · Oct 2020
ReviewAn overview of management of intracranial hypertension in the intensive care unit.
Intracranial hypertension (IH) is a clinical condition commonly encountered in the intensive care unit, which requires immediate treatment. The maintenance of normal intracranial pressure (ICP) and cerebral perfusion pressure in order to prevent secondary brain injury (SBI) is the central focus of management. SBI can be detected through clinical examination and invasive and non-invasive ICP monitoring. ⋯ To control elevated ICP refractory to maximum standard medical and surgical treatment, at first, high-dose barbiturate administration and then decompressive craniectomy as a last step are recommended with unclear and probable benefit on outcomes, respectively. The therapeutic strategy should be based on a staircase approach and be individualized for each patient. Since most therapeutic interventions have an uncertain effect on neurological outcome and mortality, future research should focus on both studying the long-term benefits of current strategies and developing new ones.